MULTIPLE-CHOICE TESTS:
CHOOSE THE CORRECT ANSWER/STATEMENT:
1. A child of 3 suddenly fell sick 16 hours ago with a sudden rise in temperature to 39C and
abdominal pain around the umbilicus. There was repeated vomiting and diarrhea. The
general state of the child was severe with a heart rate of 140 per min., muscular rigidity in
the right iliac fossa. What is the most probable diagnosis?
A. Acute appendicitis
B. Acute gastritis
C. Acute gastroduodenitis
D. Gastroenteritis
E. Peritonitis
2. Diarrhea has been defined as a probable albeit not constant feature of acute
appendicitis. In which of the following cases is this sign likely to be evident?
A. In the first day of illness
B. In patients with a very high temperature
C. Pelvic position of the vermiform appendix
D. Retroperitoneal position of the vermiform appendix
E. In prolonged illness
3. A child of 2 and a half presented with abdominal pains, emesis and a high temperature
of 37.6C. The physical signs elicited did not point to a diagnosis of acute appendicitis. What
should be the physician’s course of action?
A. Repeat the examination in 12 hrs
B. Repeat the examination in 24 hrs
C. Immediate hospitalization and continuous monitoring
D. Discharge the patient
E. Prescribe an analgesic and antibiotics
4. In which position of the vermiform appendix is the rectal examination most
informative?
A. Retrocecal
B. Pelvic
C. Postileal
D. Medial
E. Paracecal
5.
Which of the following signs is the most useful in diagnosis of acute appendicitis
in a febrile child of 8 presented with abdominal pains and emesis?
A. Local tenderness in the right iliac fossa
B. Local tenderness and muscular rigidity in the mesogastrium
C. Rigidity around the umbilicus
D. Local tenderness and muscular rigidity in the right iliac fossa
6.
Which of the following is the correct classification of peritonitis based on clinical
manifestations?
A. Infectious and non-infectious
B. Bilious, calculous and urinary
C. Acute and chronic
D. Serous, fibrous and purulent
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E. Localized and diffuse
7. Which of the following is NOT an early complication of acute appendicitis?
A. Peritonitis
B. Intestinal fistula
C. Aspiration pneumonia
D. Ligature fistula
E. Suppuration
8.
A child of 3 was taken ill 2 hrs ago with right iliac fossa and suprapubic
abdominal pains, a body temperature of 38.2C, recurrent emesis and diarrhea. On examination,
the abdomen was found to be tense around the umbilicus and in the lower regions. Signs of
peritoneal irritation were positive with a muco-purulent vaginal discharge. Your diagnosis:
A. Acute appendicitis
B. Primary peritonitis
C. Acute intestinal obstruction
D. Acute non-specific mesenteric adenitis
E. Pelvic inflammatory disease
9.
A boy of 12 presented with abdominal pains and a fever lasting for the past 3
days. On examination an abdominal mass was suspected. Which of the following would be most
effective in verifying this diagnosis?
A. Plain abdominal radiograph
B. Endoscopy
C. Contrast abdominal radiography
D. Rectomanoscopy
E. Ultrasonography
10.
What should be the surgeon’s course of action in an intra-operative finding of an
appendix mass while operating on a child of 12 for acute destructive appendicitis?
A. Drainage of the peritoneal cavity without an appendectomy
B. Continue the appendectomy as usual
C. Complete closure of the peritoneal cavity without appendectomy
D. Remove the mass
E. Appendectomy with subsequent drainage of the peritoneal cavity
11. Which of the following is not a direct complication of acute appendicitis
A. An appendix mass
B. Appendiceal abscess
C. Local peritonitis
D. Diverticulitis
E. Diffuse peritonitis
12. During the past week a one month old infant was reported to have been having
projectile vomiting. The child was in a severe state, adynamic with 2nd degree hypotrophy. On
palpation, the abdomen was found to be soft, intestinal peristalsis of the “sand-clock” was
evident. Which investigation would prove most appropriate at arriving at a diagnosis?
A. Gastro-duodenoscopy
B. Plain radiography
C. Ultrasonography
D. Thermography
E. CT scan
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13. Esophageal atresia is diagnosed immediately after birth on the basis of:
A. Excessive salivation and foaming at the mouth
B. Excessive vomiting on feeding
C. Esophageal catheterization
D. Respiratory distress
E. Abdominal distention
14 . Which of the following is the most informative in diagnosing Ladd’s syndrome?
A. Complete blood count
B. Plain thoracic radiography
C. Bronchoscopy
D. Contrast radiography
E. Plain abdominal radiography
15. On a plain abdominal radiograph two liquid levels were visible. This testifies to the child
having:
A. Pyloric atresia
B. Ileal atresia
C. Hirschsprung’s disease
D. Ladd’s syndrome
E. Duodenal atresia
16. The most effective method of treating Ladd’s syndrome is:
A. Conservative management
B. Ladd’s operation
C. Soave’s operation
D. Colostomy
E. Hirschsprung’s operation
17. Which of the following is the pathogenetic basis for meconium ileus?
A. Congenital hepatitis
B. Ileal stenosis
C. Pancreatic cystic fibrosis
D. Portal hypertension
E. Volvulus neonatorum
18. Towards the end of the first day of life, the neonate was observed to have bilious
emesis after each feeding, earlier viscous grayish meconium had been discharged. A plain
abdominal radiograph revealed two levels of liquid in the epigastrium and absence of gas in the
lower gut. Which is the most probable diagnosis?
A. Hirschsprung’s disease
B. Meconium ileus
C. Esophageal atresia
D. Diaphragmatic hernia
E. Ladd’s syndrome
19. A positive Farber’s test is indicative of which pathological state?
A. Ladd’s syndrome
B. Ileal stenosis
C. Duodenal stenosis
D. Pancreatic cystic fibrosis
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E. Duodenal atresia
20. Which of the following is not a component of meconium disease of infancy?
A. Meconium ileus
B. Meconium peritonitis
C. Meconium plug syndrome
D. Meconium ileus equivalent (MIE)
E. Meconium stenosis syndrome
21. The conservative method of meconium ileus management is:
A. Gastrografin enema
B. Antibacterial therapy
C. Spasmolytic drugs
D. Intravenous infusion
E. Ultrasound therapy
22. Marked abdominal distention was noticed in the fifth day of life of a neonate female
with intestinal loops visible on the anterior abdominal wall. Meconium was discharged after an
enema. On a plain abdominal radiograph, the large intestine was found to be distended. What is
the most probable diagnosis?
A. Ladd’s syndrome
B. Ileal stenosis
C. Hirschsprung’s disease
D. Portal hypertension
E. Intususception
23. A neonate in whom the anus was noted to be absent was observed to be occasionally
passing urine with traces of meconium, and clear urine on other occasions. Which type of
anomaly is present?
A. Anal atresia
B. Anal atresia with rectourethral fistula
C. Anal atresia with rectovesical fistula
D. Rectal atresia
E. Cloacal malformation
24. Which of the following is the most informative in diagnosis of HD?
A. Biopsy
B. Plain radiography
C. Contrast radiography
D. Endoscopy
E. Ultrasonography
25. Which of the following is not a method of surgical management in HD?
A. Duhamel’s operation
B. Swenson’s operation
C. Soave’s operation
D. Ladd’s operation
E. Rehbein’s operation
26. Which is not indicative of HD?
A. Aganglionic bowel on biopsy
B. Abnormal recto-anal inhibitory reflex
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C. Abdominal distention
D. Abdominal pain
E. Constipation
27. A child aged 5 months was fed carrots for the first time became irritated and there
was recurrent vomiting. The general state was moderately severe, the abdomen was not
distended and on palpation was soft. Rectal exam revealed a viscous mucoid bloody discharge.
Which of the following diagnoses comes to mind?
A. Ladd’s syndrome
B. Intestinal polyposis
C. Hirschsprung’s disease
D. Portal hypertension
E. Intussusception
28. Which symptom is not characteristic of paralytic ileus?
A. Abdominal pain
B. Constipation
C. Increased peristalsis
D. Vomiting
E. Abdominal distention
29. Which of the following is the least informative in diagnosis of intussusception?
A. Endoscopy
B. Plain radiography
C. Contrast radiography
D. Biopsy
E. Ultrasonography
30. Which symptom is not characteristic of intussusception?
A. Abdominal pain
B. Constipation
C. Increased peristalsis
D. Abdominal distention
E. Vomiting
31. Which is not indicative of intussusception?
A. Aganglionic bowel on biopsy
B. Sausage-shaped abdominal mass
C. “Target” lesion and “pseudo-kidney” on ultra-sound investigation
D. Hyper-peristaltic rushes
E. Dilated loops of bowel and air fluid levels on plain abdominal radiograph
32. Which of the following is not a symptom of possible blood loss?
A. Pallor
B. Weakness
C. Tachycardia
D. Hypertension
E. Weak pulse
33. Which symptom is not characteristic of portal hypertension?
A. Intestinal perforation
B. Caput Medusae
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C. Hematemesis
D. Melena
E. Hypersplenism
34. Which of the following is not a sign of possible blood loss?
A. Low BP
B. Melena
C. Hematemesis
D. Bloody stool
E. Excessive vomiting
35. Which of the following is the most informative in the diagnosis of rectal polyps?
A. Radiography
B. Ultrasonography
C. Rectoscopy
D. CBC
E. CT scan
36. Which is not a possible complication of a Meckel’s diverticulum ?
A. Hemorrhage
B. Hypersplenism
C. Intussusception
D. Inflammation
E. Perforation
37. During inguinal herniotomy in a 12 year old the testis was found in the hernia sac. What type
of hernia is this?
A. Richter’s hernia
B. Congenital indirect hernia
C. Acquired direct hernia
D. Direct hernia
E. Femoral hernia
38. A hernia containing the vermiform appendix in its sac is known as:
A. Richter’s hernia
B. Amyand’s hernia
C. Littre’s hernia
D. Omentocele
E. Indirect hernia
39. An exomphalos is:
A. A strangulated umbilical hernia
B. Synonymous with an omphalocele
C. A strangulated femoral hernia
D. A strangulated inguinal hernia
E. A sliding hernia
40. Which of the following hernias is diaphragmatic?
A. Richter’s hernia
B. Bogdalech’s hernia
C. Amyand’s hernia
D. Littre’s hernia
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E. None of the above
41. A patent processus vaginalis can lead to all of the following, except:
A. Funiculocele
B. Omphalocele
C. Bubonocele
D. Scrotal hernia
E. Hydrocele
42. The approach in aspiration of a pyothorax should be:
A. In the third/fourth intercostal space along the midline
B. Sixth/seventh intercostal space along the midline
C. Sixth/seventh intercostal space along mid-axillary line
D. Third/fourth intercostal space along the anterior axillary line
E. Fifth intercostal space along the posterior axillary line
43. The approach in opening a closed, tense pyopneumothorax should be in the:
A. Third/fourth intercostal space along the midline
B. Third/fourth intercostal space along the anterior axillary line
C Seventh intercostal space along the midline
D. In the third/fourth intercostal space along the midline
E. Second intercostal space along the posterior axillary line
44. Which of the following is considered a benign outcome of staphylococcal pulmonary
destruction?
A. Pyothorax
B. Empyema
C. Emphysematous cyst (bulla)
D. Lung abscess
E. None of the above
45. Which is not a possible outcome of staphylococcal pneumonia?
A. Pyothorax
B. Pneumothorax
C. Empyema
D. Emphysematous cyst
E. Hydatid cyst
46. A cortical abscess requires:
A. Surgical management
B. Observation
C. Anti-bacterial, anti-inflammatory and symptomatic therapy
D. Aspitation
E. None of the above
47. Which of the following is not an anorectal abscess type?
A. perianal
B. submucous
C. pelviorectal
D. ischiorectal
E. subrectal
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48. The medical term for a boil is:
A. furuncle
B. carbuncle
C. cellulitis
D. apocrinitis
E. impetigo
49. Hidradenitis suppurativa is a purulent inflammatory process of the:
A. apocrine glands
B. hair follicles
C. subcutaneous tissues
D. eyelash follicles
E. None of the above
50. Which of the following is a likely late complication omphalitis?
A. Portal hypertension
B. Omphalocele
C. fistula
D. Internal hemorrhage
E. None of the above
51.
A.
B.
C.
D.
E.
The first radiological features of acute osteomyelitis appear:
by the end of the first day
during the first week
after the first week
immediately the patient presents
in the first few hours of illness
52. The earliest radiologic finding in acute osteomyelitis is:
A. an elevated periosteum
B. osteomalacia
C. sequestration
D. fistula formation
E. osteoporosis
53. Which is not an atypical form of osteomyelitis?
A.
B.
C.
D.
E.
Sclerosing osteomyelitis
Paget’s disease
Albuminous osteomyelitis
Brodie’s abscess
Osteomyelitis antibiotica
54. Presence of a sequestrum and fistulas is indicative of:
A. Acute osteomyelitis
B. Chronic osteomyelitis
C. Brodie’s abscess
D. Albuminous osteomyelitis
E. None of the above
55. Which of the following is not a likely outcome of an osteomyelitic process?
8
A.
B.
C.
D.
E.
Involvement of the joints
Amyloid disease
Deformity
Pott’s disease
Spontaneous fractures
56. Congenital absence of one of the testes is known as:
A.
B.
C.
D.
E.
anorchia
monorchism
ectopia
dystopia
cryptorchidism
57. Cryptorchidism is most frequently found:
A. bilaterally
B. on the right side
C. retroperitoneally
D. in the abdomen
E. on the left side
58. All are possible complications of an undescended testis except:
A. malignization
B. acute scrotum
C. torsion and trauma
D. hypoplasia
E. sterility
59 Which is not a surgical emergency?
A. Testicular torsion
B. Phimosis
C. Paraphimosis
D. Torsion of testicular appendages
E. Testicular trauma
60. Neonatal testicular torsion is:
A. intra-vaginal
B. complete
C. incomplete
D. extra-vaginal
E. necrotic
61. A dark red strawberry-like swelling that empties on pressure is most likely a :
A.
B.
C.
D.
E.
hemangioma
lymphangioma
fibroma
dermoid cyst
teratoma
62. A Wilms’ tumor is a:
9
A.
B.
C.
D.
E.
hemangioma
nephroblastoma
carcinoma
seminoma
lipoma
63. Which of the following is the most rational in diagnosis of a palpated peritoneal
tumor stretching from the liver to the pelvic region?
A.
B.
C.
D.
E.
Excretory urography
Plain abdominal radiograph
biopsy
pneumoperitoneum
laparoscopy
64. A bilateral Wilms’ tumor requires:
A. nephrectomy
B. radiotherapy
C. nephrectomy and post-operative radiotherapy
D. radiotherapy and chemotherapy
E. chemotherapy
65. According to its classification, which of the following is not a hemangioma:
A. simple
B. cavernous
C. capillary
D. mixed
E. complex
66. Which is not an intrinsic cause of uretero-pelvic junction obstruction?
A.
B.
C.
D.
E.
Aberrant renal artery
Localized inflammatory process
Ureteral polyps
Congenital absence of ureteric smooth muscle
Ureteral leiomyoma
67. All of the following can be causes of hydronephrosis except:
A.
B.
C.
D.
E.
aberrant renal vessels
high insertion of the ureter
congenital absence of ureteric smooth muscle
undescended testis
ureteral polyps
68. Which of the following is a contra-indication to catheterization of the urinary
bladder?
A.
B.
C.
D.
hematuria
urethral trauma
prostate adenoma
neoplasm of the bladder
10
E. chronic cystitis
69. Which of the following gives an objective quantitative assessment of micturition?
A. urethrography
B. chromocystoscopy
C. uroflowmetry
D. sphincterometry
E. urochimography
70. Which of the following radiologic investigations is used to reveal vesicoureteral
reflux?
A.
B.
C.
D.
E.
excretory urography
pneumocystography
voiding cystography
retrograde ureteropyelography
plain abdominal radiograph
71. The principal cation of extracellular fluid is:
A. magnesium
B. calcium
C. chloride
D. sodium
E. potassium
72. The normal serum sodium value is:
A. 3 – 5 mmol/l
B. 90 – 110 mmol/l
C. 0.7 – 0.9 mmol/l
D. 135-150 mmol/l
E. 20- 50 mmol/l
73. Which ion is necessary for blood coagulation and neuromuscular excitability?
A. potassium
B. magnesium
C. calcium
D. chloride
E. sulphate
74. Which contains sodium, potassium and chloride in almost the same concentration as
in the plasma?
A. Ringer’s lactate solution
B. isotonic saline solution
C. Darrow’s solution
D. 5% dextrose solution
E. 5% glucose solution
75.
A.
B.
C.
D.
Which of the following signs is not likely in a case of water intoxication?
vomiting of clear fluid
a high hematocrit
dilute urine
considerable amounts of urine
11
E. coma
76. During a laproscopic examination of the deep surface of the lower anterior abdominal
wall (using a lighted scope on a thin tube inserted through the wall), the attending physician
noted something of interest and asked the young resident to look at the medial inguinal fossa. To
do so, the young doctor would have to look at the area between the:
A.
B.
C.
D.
E.
inferior epigastric artery and urachus
obliterated umbilical artery and urachus
inferior epigastric artery and lateral umbilical fold
obliterated umbilical artery and inferior epigastric artery
median umbilical ligament and medial umbilical ligament
77. If one were to make an incision parallel to and 2 inches above the inguinal ligament,
one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper's and Scarpa's fascias
A.
B.
C.
D.
External abdominal oblique and internal abdominal oblique muscles
Internal abdominal oblique and transversus abdominis muscles
Skin and deep fascia of the abdominal wall
Tranversus abdominis muscle and peritoneum
78. A man is moving into a new house and during the process lifts a large chest of drawers.
As he lifts he feels a severe pain in the lower right quadrant of his abdomen. He finds that he can
no longer lift without pain and the next day goes to see his physician. Surgery is indicated and
during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small
knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and
lateral to the inferior epigastric vessels. The hernia was diagnosed as:
A.
B.
C.
D.
A congenital inguinal hernia
A direct inguinal hernia
A femoral hernia
An incisional hernia
79. An indirect inguinal herniaWhich structure passes through the deep inguinal ring?
A.
B.
C.
D.
E.
Iliohypogastric nerve
Ilioinguinal nerve
Inferior epigastric artery
Medial umbilical ligament
Round ligament of the uterus
80. A loop of bowel protrudes through the abdominal wall to form a direct inguinal
hernia; viewed from the abdominal side, the hernial sac would be found in which region?
A. Deep inguinal ring
B. Lateral inguinal fossa
C. Medial inguinal fossa
12
D. Superficial inguinal ring
E. Supravesical fossa
81. In a female with an indirect inguinal hernia, the herniated mass lies along side of
which structure as it traverses the inguinal canal?
A.
B.
C.
D.
E.
Iliohypogastric nerve
Inferior epigastric artery
Ovarian artery and vein
Pectineal ligament
Round ligament of the uterus
82. While performing a routine digital examination of the inguinal region in a healthy
teen-aged male, the physician felt a walnut-sized lump protruding from the superficial inguinal
ring. She correctly concluded that it was :
A.
B.
C.
D.
E.
definitely an indirect inguinal hernia
possibly an unusual femoral hernia
definitely a direct inguinal hernia
possibly an enlarged superficial inguinal lymph node
either a direct or an indirect inguinal hernia
83. A pediatrician has diagnosed a newborn baby of having right-sided cryptorchidism
(undescended testis). The testis may have been trapped in any site EXCEPT:
A.
B.
C.
D.
E.
At the deep inguinal ring
Just outside the superficial inguinal ring
Pelvic brim
Perineum
Somewhere in the inguinal canal
84. A 15-year-old boy was admitted to the emergency room for having large bowel
obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal
segment involved in this obstruction is the:
A.
B.
C.
D.
E.
ascending colon
cecum
descending colon
rectum
sigmoid colon
85. Which nerve passes through the superficial inguinal ring and may therefore be endangered
during inguinal hernia repair?
A.
B.
C.
D.
E.
Femoral branch of the genitofemoral
Ilioinguinal
Iliohypogastric
Obturator
Subcostal
13
86. During exploratory surgery of the abdomen, an incidental finding was a herniation of
bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the
inferior epigastric vessels. These boundaries defined the hernia as a(n)
A.
B.
C.
D.
E.
Congenital inguinal hernia
Direct inguinal hernia
Femoral hernia
Indirect inguinal hernia
Umbilical hernia
87: Pulmonary function testing performed as long-term follow-up care of pediatric
patients treated for parapneumonic effusions reveals which of the following?
A: Persistent restrictive lung defect
B: Hypoxemia
C: Mild expiratory flow limitation
D: Reduced exercise tolerance from restrictive ventilatory limitations
E: None of the above
88. Which of the following is not included regularly in pediatric management of
complicated parapneumonic effusions?
A: Video-assisted thoracoscopic surgery
B: Rib resection with open drainage
C: Antibiotic infusion
D: Recombinant tissue plasminogen activator
E: Decortication and debridement
89. What organ systems are affected by CF and what are the clinical manifestations?
A: Pulmonary
B: Gastrointestinal
C: Hepatic
D: Reproductive
E: All of the above
90. How is CF inherited?
A: Autosomal Dominant
B: Autosomal Recessive
C: Sex-linked Recessive
E: None of the above
14
91. A 10-month-old girl has had vomiting and diarrhea for 3 days. She has not had a wet
diaper in 18 hours, her heart rate is 140 beats per minute, her respiratory rate is 40 breaths per
minute, and her blood pressure is 75/35 mm Hg. Examination shows a minimally responsive
infant with cool extremities, 4-second capillary refill, parched lips, and very sunken eyes. Which
of the following best describes her state of hydration?
A: Mild dehydration
B: Moderate dehydration
C: Severe dehydration
D: Normal hydration
E: Hypervolemic
92: A 10-month-old girl has had vomiting and diarrhea for 3 days. She has not had a wet
diaper in 18 hours, her heart rate is 140 beats per minute, her respiratory rate is 40 beats per
minute, and her blood pressure is 75/35 mm Hg. Examination shows a minimally responsive
infant with cool extremities, 4-second capillary refill, parched lips, very sunken eyes, and a
currently weight of 8 kg. What is her estimated fluid deficit?
A: 300 mL
B: 500 mL
C: 900 mL
D: 1000 mL
E: 1200 mL
93. A 5-year-old presents to the clinic with a 1-week history of vomiting and a 3-day
history of abdominal pain. His mother notes a weight loss of approximately 10 pounds and
reports that he has been wetting the bed. Vital signs are heart rate (HR) 135 beats per minute,
respiratory rate (RR) 40 breaths per minute (deep), and blood pressure (BP) 90/54 mm Hg. He is
afebrile and sleepy. His mucous membranes are dry. Capillary refill is 4 seconds. Heart, lungs,
and abdominal examination findings are normal. Laboratory data include glucose of 560, sodium
of 140, potassium 5, chlorides 100, CO2 content 4, BUN 35, and creatinine 2.0. Arterial blood
gas shows pH of 7.02, PCO2 30, PO2 100 on room air, and HCO3 4. Evaluation of his blood gas
values indicates which of the following?
A: He has a respiratory alkalosis with metabolic compensation.
B: The low pH is due to a high blood sugar.
C: He has metabolic acidosis with inadequate respiratory compensation.
D: His blood gas is within the reference range.
E: He has severe hypoxemia.
94. A physician examines a 12-year-old girl with a 4-week history of intermittent lower
abdominal pain and rectal bleeding. Her laboratory workup reveals hemoglobin of 9.9 g/dL,
normal erythrocyte sedimentation rate and albumin, and normal stool studies (eg, culture and
Clostridium difficile toxins A and B). Her growth is adequate. The colonoscopy findings are
significant for the confluent moderate inflammation of the rectum, sigmoid, and distal
descending colon, and biopsies reveal chronic inflammation with crypt abscesses and
15
architectural crypt changes. Findings from an upper GI series with a small bowel follow-through
are normal. What is the correct diagnosis?
A: Ulcerative colitis (UC)
B: Crohn disease
C: Viral colitis
D: Allergic colitis
E: Hemolytic-uremic syndrome
95. Gynecomastia in patients with Peutz-Jeghers syndrome warrants thorough evaluation
to exclude testicular or gynecologic malignancy.
A: Testicular or ovarian tumor
B: Cirrhosis
C: Gastrointestinal polyps
D: Hyperthyroidism
E: Polyps
96. According to current research data, which of the following polyposis syndromes
arises from a nongenetic etiology?
A: Gardner syndrome (ie, familial adenomatous polyposis syndrome)
B: Gorlin syndrome (ie, basal cell nevus syndrome)
C: Bannayan-Riley-Ruvalcaba syndrome (ie, Bannayan-Zonana syndrome)
D: Peutz-Jeghers syndrome
E: Cronkhite-Canada syndrome
97. A 1-week-old breastfed male infant is brought to a local emergency department for
sudden onset of vomiting. The parents describe the emesis as forceful and bright yellow to green
in color. The infant appears sleepy and has delayed capillary refill. Abdominal plain radiography
shows some gas in the stomach but none in the bowel. Which of the following is the most
appropriate intervention at this time?
A: Administer intravenous fluids and admit the patient for observation in the hospital.
B: Ask the parents to feed the infant an oral rehydration fluid and determine whether
he tolerates it.
C: Stabilize the patient and transfer him to a facility that has pediatric surgical
support.
D: Reassure the parents and allow the mother to continue breastfeeding.
E: Repeat the abdominal radiography because lack of gas in the bowels may have
been related to poor technique.
16
98. Which of the following is the cause of predisposition for midgut volvulus in patients
with malrotation?
A: Twisting of the bowel on itself while the bowel is returning to the abdominal cavity
from physiologic herniation
B: Formation of a narrow-base mesentery as the gut lengthens on the superior
mesenteric artery without rotation
C: Improperly formed peritoneal bands that pull the bowel into a twisted position
D: Arrest in development at stage III of normal embryological gastrointestinal
development
E: None of the above
99. Which of the following does not cause bilious vomiting in an infant or child?
A: Intestinal malrotation and volvulus
B: Pyloric stenosis
C: Duodenal atresia
D: Small bowel obstruction
E: Ulcerative colitis with colonic obstruction
100. Which of the following statements is incorrect?
A: At the fourth week of gestation, the GI tract is a straight tube centrally located in
the fetal abdomen.
B: During the fifth week of gestation, the first stage of rotation begins and lasts until
the tenth week.
C: The superior mesenteric artery has its axis in line with the omphalomesenteric duct,
and the primitive gut normally rotates in a counterclockwise direction.
D: The second stage of rotation occurs between the tenth and twelfth weeks of
gestation and involves the return of the intestine to the fetal abdominal cavity.
E: At the completion of the normal rotation, the duodenojejunal junction is not fixed
to the left of the aorta and the cecum has loose attachments to the right abdominal
wall.
101. A 10-year-old boy presents with chronic recurrent abdominal pain. Which of the
following additional symptoms is not consistent with the diagnosis of irritable bowel syndrome
(IBS)?
A: Onset of symptoms at age 6 years
B: Mucus with stool
C: Diarrhea with pain attacks
D: Weight loss
E: Defecation associated with prolonged straining and a sense of incomplete
evacuation
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102. A 15-year-old girl is diagnosed with irritable bowel syndrome (IBS). What is the
long-term outcome of her illness?
A: Periodic abdominal pain and altered bowel habit
B: Resolution of symptoms and cure of illness with proper treatment
C: Inflammatory bowel disease
D: Higher risk to develop colon cancer
E: All of the above
103. A 15-month-old boy who was previously healthy presents with a 24-hour history of
cramping abdominal pain, bilious vomiting, and abdominal distention. His stools are heme
positive. Which of the following is the most likely diagnosis?
A: Midgut volvulus
B: Acute gastroenteritis
C: Idiopathic intussusception
D: Acute appendicitis
E: Gastroesophageal reflux disease
104. An 8-year-old boy presents with acute onset of cramping abdominal pain and
vomiting. He has multiple maculopapular rash spots on his lower extremities. Which of the
following is the most likely diagnosis?
A: Acute appendicitis
B: Henoch-Schцnlein purpura
C: Kawasaki disease
D: Crohn disease
E: Sickle cell crisis
105. Which of the following is the most common type of ectopic tissue found in Meckel
diverticulum?
A: Pancreatic
B: Colonic
C: Endometrial
D: Gastric
E: Jejunal
106. Which of the following is the most common cause of intestinal obstruction in
patients with Meckel diverticulum?
A: Volvulus around vitelline duct remnants
B: Omphalomesenteric band
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C: Volvulus through vitelline duct remnants
D: Leiomyoma
E: Internal hernia
107. What is the most likely diagnosis in an infant or young child with a history of
intermittent swelling in the groin region?
A: Direct inguinal hernia
B: Indirect inguinal hernia
C: Varicocele
D: Adenopathy
E: None of the above
108. What is the best diagnostic test for the assessment of inguinal hernia in children?
A: Ultrasonography
B: Plain radiography
C: CT
D: MRI
E: None of the above
109. Which of the following complications is known to occur in children or infants with
peptic ulcer disease (PUD)?
A: Perforation
B: Hemorrhage
C: Anemia
D: Obstruction
E: All of the above
110. Which of the following etiologic factors is not associated with an increased risk for
developing peptic ulcer disease (PUD)?
A: Use of nonsteroid anti-inflammatory drugs (NSAIDs)
B: Brain injury
C: Milk intake
D: Helicobacter pylori infection
E: Alcohol intake
111. A 1-month-old male infant is brought to the office with a 5-day history of
nonbilious vomiting. He has been otherwise healthy. Over the last 3 days, his parents have
switched formulas twice on the advice that the child has formula intolerance. The child now
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vomits 5-15 minutes after every feeding, usually forcefully. Skin turgor is decreased and the
fontanelle is depressed. What is the most likely diagnosis?
A: Gastroesophageal reflux
B: Lactose intolerance
C: Malrotation and midgut volvulus
D: Infantile hypertrophic pyloric stenosis
E: Sepsis
112. Persistent vomiting with hypertrophic pyloric stenosis usually causes what
electrolyte imbalance?
A: Metabolic acidosis
B: Metabolic alkalosis
C: Respiratory acidosis
D: Respiratory alkalosis
E: None of the above
113. A 12-year-old boy presents with a 3-week history of abdominal cramping, diarrhea,
and hematochezia. Stool culture results are negative. Fecal testing is negative for Clostridium
difficile toxins A and B. Findings on upper GI series with small bowel follow-through are
normal. Colonoscopy reveals a confluent colitis beginning in the rectum and extending
proximally to the splenic flexure. Biopsies reveal diffuse cryptitis. What is the most likely
diagnosis?
A: Crohn disease (CD)
B: Hemolytic-uremic syndrome
C: Ulcerative colitis (UC)
D: Meckel diverticulum
E: Appendicitis
114. A 16-year-old male adolescent with ulcerative colitis develops abdominal pain,
abdominal distention, high fever, and toxic appearance. Abdominal radiography shows dilated
loops of colon with multiple air/fluid levels. What is the next most appropriate step in the
treatment of this patient?
A: Barium enema
B: Surgical consultation
C: Colonoscopy
D: Intravenous steroids
E: Intravenous cyclosporin
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115. A 15-year-old adolescent boy has had gradual and persistent lymph node
enlargement for the last 5 months. Lymph nodes are firm, nontender, and located in the right
cervical area. Accompanying symptoms include weight loss, intermittent fever, and night sweats.
Which of the following causes of lymphadenitis is the most likely diagnosis?
A: Tuberculosis
B: Hodgkin lymphoma
C: Infectious mononucleosis
D: Non-Hodgkin lymphoma
E: Catscratch disease
116. A 6-year-old boy has a 2-day history of swelling in the right side of the neck and
fevers up to 101.5°F. Examination of the right anterior cervical region shows a 4-cm firm tender
mass with erythema of the overlying skin. The child has no sick contacts that may explain
lymphadenitis. Which of the following initial procedures should be used in this patient?
A: Empiric antibiotic therapy
B: Throat swab for culture of the pharynx
C: Lateral neck x-ray
D: Incision and drainage
E: No action
117. A 15-month-old child recently adopted from China is brought in with septic arthritis
of the knee. After blood and aspirate cultures are obtained, the patient is started on cefazolin 100
mg/kg/d. Next-day laboratory results report gram-negative pleomorphic rods in the blood
culture. Which of the following is not appropriate management?
A: Perform a careful physical examination. If no new findings are present, continue
cefazolin.
B: Perform a careful physical examination. If no new findings are present, switch to
cefuroxime 200 mg/kg/d.
C: Patient and other siblings need chemoprophylaxis for Haemophilus influenzae type
b (Hib).
D: Report the case to the health department.
E: Immunize the patient with Hib vaccine after recovery.
118. A newborn presents with a scaphoid abdomen and bilious emesis. Massive intestinal
loss could occur if which one of the following causes of neonatal bowel obstruction is not
quickly identified and treated?
A: Pyloric stenosis
B: Malrotation with volvulus
C: Meconium ileus
D: Hirschsprung disease
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E: Congenital diaphragmatic hernia
119. Thirty-six hours after delivery, an otherwise healthy term infant has not yet passed
meconium (has not yet had a bowel movement). Which one of these modalities would not be an
appropriate step in the child's workup?
A: Suction rectal biopsy
B: Contrast enema
C: Colonoscopy
D: Chromosomes for delta F-508
E: Plain abdominal radiography
120. A 10-day-old infant of 23 weeks’ gestation has increasing oxygen and ventilator
requirements to maintain normal blood gases over the past 48 hours. Which of the following
should not be included in the differential diagnosis for the increased ventilator and oxygen
requirements?
A: Onset of bronchopulmonary dysplasia (BPD)
B: Symptomatic patent ductus arteriosis (PDA)
C: Nosocomial infection
D: Retinopathy of prematurity
E: All of the above
121. A 3-day-old infant is seen for his hospital discharge examination. He is the 3650gram, Coombs negative infant of a 20-year-old primigravida mother with an uncomplicated
pregnancy, labor, and delivery. He is breastfeeding fairly well, but the mother's breast milk is
only beginning to increase today. His circumcision has some oozing, and his heel is still bleeding
from blood sampling an hour ago. He is mildly jaundiced, but the physical examination is
otherwise unremarkable. What should the initial workup include?
A: Vitamin K level
B: Cranial ultrasound or CT scan
C: Prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen
levels, CBC, and platelet count
D: All of the above
E: Only A and C
122. A 3-day-old infant who weighs 3650 grams and was born to a 20-year-old
primigravida mother with an uncomplicated pregnancy, labor, and delivery is breast-feeding
fairly well, but the mother's breast milk is only beginning to increase today. His circumcision has
some oozing, and his heel is still bleeding from blood sampling an hour ago. He is mildly
jaundiced, but the physical examination is otherwise unremarkable. The CBC shows a
hematocrit of 62, the bilirubin is 12 mg/dL, the prothrombin time (PT) is twice the value of the
control, and the remainder of the tests are within normal range. Review of the chart shows that
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erythromycin eye prophylaxis was administered, but no record of vitamin K dosing can be
found. What is the most appropriate next step?
A: Send out protein induced by vitamin K antagonism (PIVKA)-II and vitamin K
levels.
B: Administer 1 mg vitamin K IM.
C: Discharge with follow-up in 2 days.
D: Administer 1 mg vitamin K IV.
E: Discontinue breast-feeding and begin infant formula.
123. A 3-week-old, ex-27 week premature infant has increased abdominal girth and 10
mL of green-tinged gastric residual. The patient has been tolerating enteral feedings of 20-calorie
premature formula and was increased to a 24-calorie formula yesterday. The patient has had
slightly more bradycardia episodes with desaturation today. Bowel sounds cannot be appreciated
on auscultation, but results of serum electrolytes and CBC are within the reference range. The
abdominal radiograph is as shown. Which of the following is not part of the appropriate
immediate management of this infant?
A: Draw blood cultures and begin broad-spectrum antibacterials.
B: Hold one feeding and then continue with previous feeding regimen.
C: Consult a pediatric surgeon as soon as possible.
D: Place the baby on nothing by mouth (NPO) and begin total parenteral nutrition for
at least 7 days.
E: Place a large-bore gastric catheter for bowel decompression.
124. A 62-day-old female infant presents with a 4-week history of periumbilical
erythema unresponsive to topical antibiotics. The umbilical cord did not separate until day 48.
Records reveal that a previous sibling died in infancy. Which of the following diagnoses is most
likely?
A: Bruton agammaglobulinemia
B: Congenital HIV infection
C: Leukocyte adhesion deficiency
D: Adenosine deaminase deficiency
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E: Selective immunoglobulin A deficiency
125. A 28-day-old infant presents with a 3-day history of increasing periumbilical
erythema. On examination, the diaper is removed and a distinct greenish brown staining is
discovered that overlies the umbilical region at the top of the diaper. The mother comments that
this is a common finding. Which of the following diagnoses is most likely?
A: Patent urachus
B: Neonatal alloimmune neutropenia
C: Maple syrup urine disease
D: Homocystinuria
E: Patent omphalomesenteric duct
126. Upon delivery of a baby with a small intact omphalocele and an enlarged tongue,
which of the following is foremost in the physician’s mind in the management of this infant?
A: Cover the omphalocele membrane with plastic wrap to prevent loss of body
warmth and fluid.
B: Insert an orogastric tube to decompress the intestinal tract.
C: Promptly arrange consultation with a pediatric surgeon to repair the omphalocele
and assess the baby's airway.
D: Insert an IV to correct fluid and electrolyte losses.
E: Insert an IV to provide glucose.
127. A maternal ultrasound reveals a baby with gastroschisis. What should the physician
recommend to the parents regarding the baby's management?
A: Amniocentesis and elective cesarean section once lung maturity is verified
B: Serial ultrasound exams with induction of labor and vaginal delivery if
polyhydramnios develops or if the intestine appears increasingly dilated
C: Amniocentesis to determine presence of associated genetic defect
D: Fetal echocardiography to determine presence of associated cardiac defect
E: Serial ultrasound exams with delivery by cesarean section if polyhydramnios
develops or if the intestine appears increasingly dilated
128. Which of the following is the most common presentation for Wilms tumor?
A: Abdominal mass
B: Abdominal pain
C: Urinary tract infection
D: Hematuria
E: Varicocele
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129. Which of the following is not commonly part of the initial evaluation of Hodgkin
disease?
A: Chest radiograph
B: Biopsy
C: Lumbar puncture
D: Bone marrow aspirate and biopsy
E: Bone scan
130. Which of the following is the most common site of recurrence after treatment for
Wilms tumor?
A: Liver
B: Tumor bed
C: Lungs
D: Brain
E: Bone
131. Which of the following symptoms or signs is almost invariably observed in children
with bronchiectasis?
A: Headaches
B: Nightmares
C: Cough
D: Respiratory failure
E: Hemoptysis
132. Which of the following is the optimal study for the diagnosis of bronchiectasis?
A: Chest radiography
B: Sweat chloride test
C: Barium swallow
D: Chest computed tomography
E: Bronchography
133. Of all of the anomalies that constitute the exstrophy-epispadias complex, which is
the most common?
A: Cloacal exstrophy
B: Classic bladder exstrophy
C: Male epispadias
D: Female epispadias
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E: Superior vesical fissure
134. Which clinical feature is not present in cloacal exstrophy?
A: Spinal abnormality
B: Hemibladders adjacent to exposed cecum
C: Gastroschisis
D: Omphalocele
E: None of the above
135. Which of the following is not accurate regarding the repair of hypospadias?
A: Adjunctive hormonal therapy is sometimes used preoperatively.
B: Urethral stents are commonly used during healing.
C: Surgery is usually delayed until the patient is older than 3 years.
D: Penoscrotal transposition is usually repaired as a staged procedure.
E: Postoperative complications include bleeding, fistula formation, and meatal
stenosis.
136. Which of the following statements is correct?
A: Palpable varicoceles often present by age 10 years.
B: A varicocele that does not reduce when the patient is supine is grade 3.
C: Reduced total sperm count is the only semen abnormality observed with
varicoceles.
D: Serum testosterone is often below the reference range in patients with a high-grade
varicocele.
E: Left-sided varicoceles account for 90% of all cases.
137. Which of the following is not an indication for adolescent varicocele ligation?
A: Abnormal semen parameters
B: Pain with prolonged standing
C: Delayed puberty
D: Bilateral varicoceles
E: Ipsilateral volume loss greater than 20%
138. A 3-month-old uncircumcised male infant presents with a 2-day history of inability
to advance the foreskin over the glans. The mother reveals that since birth, she had been forcibly
retracting the foreskin to clean the glans. Examination reveals an edematous ring of foreskin
retracted behind the glans. After manual reduction is successfully performed, which of the
following procedures is most appropriate?
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A: Insert a urethral catheter.
B: Arrange immediate circumcision in the operating room.
C: Instruct the parents to continue forcibly retracting the foreskin to clean the glans.
D: Refer the patient to an urologist for circumcision at a later date.
E: Perform a dorsal slit procedure.
139. Expectant parents ask for help deciding if they should request neonatal circumcision
for their son. Which of the following statements should not be offered to help them make the
decision?
A: Risk of urinary tract infection is slightly higher in uncircumcised male infants.
B: Some organizations believe that the foreskin has important protective, sensory, and
sexual functions.
C: Procedural analgesia is not necessary.
D: Bleeding is the most common complication of circumcision.
E: Circumcision has reportedly been associated with various complications, including
unsatisfactory cosmesis, urinary retention, meatal stenosis, and recurrent phimosis.
140. Which of the following is the single most important determinant influencing
outcome in patients with biliary atresia?
A: Level of direct bilirubin at the time of surgery
B: Presence of dilated biliary duct remnants in the porta hepatis
C: Age at time of operation
D: Availability of a donor liver for orthotopic liver transplantation
E: Nutritional status at time of surgery
141. In the evaluation of neonatal cholestasis, which of the following is the most valuable
nonsurgical test for differentiating intrahepatic and extrahepatic etiologies?
A: Percutaneous liver biopsy
B: Real-time ultrasonography
C: Serum gamma-glutamyl transpeptidase (GGTP)
D: Hepatobiliary scintigraphy
E: Serum bile acids
142. A 4-year-old boy presents with a 5-day history of dysphagia and hoarseness. His
respiratory rate is 45 breaths per minute, and he appears to be in mild respiratory distress. He has
diffuse expiratory wheezes on chest auscultation. No other significant physical examination
findings are present. The patient, parents, and siblings deny a history of foreign body ingestion,
but his chest radiograph reveals an ingested coin. Which of the following is the most appropriate
management?
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A: Push the foreign body into the stomach with an appropriately sized bougie under
sedation (ie, midazolam, fentanyl).
B: Observation in the hospital is appropriate. This foreign body likely poses no
problem and will pass through the gastrointestinal tract without incident.
C: Protect the airway and immediately remove the foreign body under general
anesthesia with esophagoscopy.
D: Remove the foreign body with a Foley catheter under sedation.
E: Flexible endoscopic removal in the emergency department with no sedation is
recommended.
143. A mother brings in her 3-year-old child because she witnessed her son swallow a
watch battery 1 hour ago. Which of the following is the most appropriate initial step in the
management of this toddler following a history and physical examination?
A: Obtain a barium swallow.
B: Proceed directly to the operating room to perform rigid esophagoscopy.
C: Perform bougienage immediately to dislodge the battery into the stomach.
D: Obtain an extended chest radiograph to determine the location of the foreign body.
E: Do nothing because watch battery ingestion is not worrisome; it seldom results in a
complication.
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